Tips4EyeDocs Daily – 12/23/2011 – No 9 – Continuing your education


The wisdom of years of practice brings a precious chance to introspect. Over the years of active practice, I had managed hundreds of glaucoma patients of every conceivable color or shape. Yet I still wasn’t legislatively recognized to independently manage glaucoma. I thought about it long and hard and decided I’m going through the ringer once more to get that certification. After six months, I completed it.

I now look at continuing education courses just a bit different. I listen to the lecturers not with boredom, but for relevance and for gems of knowledge that I can use for the next day in the office.

There are many reasons to skip certification of any kind. But in my mind and in my heart, there is always one good reason to do so and that is to be the best doctor for your patients. I hope that my peers will follow likewise this path and maintain and master the highest level of practice within their state scope of practice. Only in this fashion can you keep optometry as exciting as the last patient you see as the first one.

A note to my readers: I’m taking a few days off to celebrate the holidays and will return with a new edition on December 27, 2011.


  1. There are 8 rules that are a great review on how to buy a point and shoot camera. The first, the myth of megapixels is my favorite. “How to buy a point and shoot digital camera” via @PCMag
  2. A new Android tablet from Motorola with a smaller screen size than the previously launched Xoom, is the Xyboard. It’s got some punch but is it enough to be above the crowd? That’s tough to say.


Clinical significance: Is there a chance that an OCT-SD can detect damage from diabetic retinopathy earlier than practically any other means?

Verma A, Raman R, Vaitheeswaran K, Pal SS, Laxmi G, Gupta M, Shekar SC, Sharma T. “Does Neuronal Damage Precede Vascular Damage in Subjects with Type 2 Diabetes Mellitus and Having No Clinical Diabetic Retinopathy?” Ophthalmic Res. 2011 Dec 16;47(4):202-207. [Epub ahead of print]


Aim: To investigate the occurrence of neuronal damage, as the earliest change occurring, before the clinical evidence of diabetic retinopathy.

Methods: 70 eyes of subjects with type 2 diabetes mellitus and with no evidence of diabetic retinopathy (cases) and 40 eyes of subjects with no diabetes mellitus (controls) were studied using spectral-domain OCT and microperimetry. The influence of age and gender on the outcome measures was also analyzed.

Results: Age- and gender-matched subjects showed a decreased mean retinal nerve fiber layer thickness in cases when compared to the controls (27 vs. 33 μm; p = 0.018). Among the cases, subjects between 40 and 45 years of age showed a reduced mean central foveal thickness (175.1 vs. 198.1 μm; p = 0.05), mean retinal thickness in the central 6-mm fundus (260.5 vs. 275.3 μm; p = 0.006) and mean retinal nerve fiber layer thickness (29 vs. 39 μm; p = 0.036) when compared to the controls. However, no differences were noted in the microperimetry outcomes in cases when compared to the controls. The duration of diabetes and the glycemic control did not show any significant changes on the outcome measures in cases, except for a significantly lower mean retinal sensitivity in diabetics with glycosylated hemoglobin values <7% as compared to those with glycosylated hemoglobin ≥7% (14.1 ± 2.9 vs. 15.4 ± 1.7 dB; p = 0.027).

Conclusion: The results suggest that there is some evidence of early neuronal damage particularly on spectral-domain OCT, before the clinical evidence of diabetic retinopathy, in subjects with type 2 diabetes mellitus.

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About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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